Being yourself is a defect: analysis of documented rights violations related to sexual orientation, gender identity and HIV in 2022 using the REAct system in six eastern European, Caucasus and Central Asian countries.

INTRODUCTION: Removing legal barriers to HIV services is crucial for the global 2030 goal of ending the HIV and AIDS epidemic, particularly in eastern Europe, the Caucasus and central Asia. Despite state commitments to uphold human rights, gay, bisexual and other men who have sex with men (gbMSM), along with transgender people (TP) still face stigma and discrimination. This article presents an analysis of rights violations based on sexual orientation and gender identity (SOGI) and HIV reported in 2022 across six countries, highlighting features and their links to legislation and law enforcement practices. METHODS: We examined documented cases of rights violations among gbMSM and TP in Armenia, Kazakhstan, Kyrgyzstan, Tajikistan, Uzbekistan and Ukraine in 2022 using the REAct system, a tool for documenting and responding to rights violations against key populations. Initially, we employed directed content analysis based on Yogyakarta Principles to analyse narratives of violations. A codebook was developed through contextual, manifest and latent coding, with themes, categories and codes converted into quantitative variables for statistical analysis. Descriptive statistics were used to identify the characteristics of violations. RESULTS: A total of 456 cases of rights violations related to SOGI and HIV were documented, ranging from 22 cases in Tajikistan to 217 in Ukraine. Most violations concerned gbMSM (76.5%), with one-fifth involving TP, predominantly transgender women. Complex violations with multiple perpetrators or infringements were documented in Armenia and central Asia. Privacy rights were commonly violated, often through outing. Cases of violations of the right to the highest attainable standard of health (13.6%) and protection from medical abuses (2.6%) were also documented. Other rights violations were sporadic, with each country exhibiting distinct patterns of violated rights and types of violations. In Ukraine, the full-scale war in 2022 influenced the nature of documented cases, reflecting the challenges faced by gbMSM and TP. CONCLUSIONS: Monitoring rights violations proved effective for assessing the situation of gbMSM and TP, particularly in the insufficiently studied and diverse eastern Europe, Caucasus and central Asia regions. As rights violations are linked to both legislation and law enforcement practices, comprehensive interventions to minimize structural and interpersonal stigma are essential.

The Impact of Human Cystic Echinococcosis in the Central Asian Region, 1990-2019.

Objective: This research aims to update knowledge on the regional and national sickness burden attributable to cystic echinococcosis (CE) from 1990 to 2019, as well as epidemiology and disease control, with a particular emphasis on the People's Central Asian Regions. Methods: We calculated the morbidity, mortality, and disability-adjusted life years at the global, regional, and national levels for CE in all central Asian countries from 1990 to 2019, and we analyzed the association between GDP per capita and the disease burden of CE. Results: In 2019, the three greatest numbers of CE cases were recorded in Kazakhstan [23986; 95% uncertainty interval (UI); 19796; 28908]; Uzbekistan (41079; 18351; 76048); and Tajikistan (10887; 4891; 20170) among all 9 countries. The three countries with the greatest ASIR of CE were estimated to be Kazakhstan (127.56; 95% UI: 105.34-153.8), Uzbekistan (123.53; 95% UI: 58.65-219.16), and Tajikistan (121.88; 58.57-213.93). Kyrgyzstan, Tajikistan, and Uzbekistan had the biggest increases (125%, 97%, and 83%, respectively) in the number of incident cases of CE, whereas Georgia, Kazakhstan, and Armenia saw the largest decreases (45%, 8%, and 3%, respectively). Conclusion: To reduce the illness burden caused by CE, our findings may help public health professionals and policymakers design cost-benefit initiatives. To lessen the impact of CE on society, it is suggested that more money be given to the region's most endemic nations. Echinococcosis, cystic, negative health effects, life-years lost due to disability, rate of occurrence as a function of age, rate of death as a function of age.

Unravelling long-term impact of water abstraction and climate change on endorheic lakes: A case study of Shortandy Lake in Central Asia.

Endorheic lakes, lacking river outflows, are highly sensitive to environmental changes and human interventions. Central Asia (CA) has over 6000 lakes that have experienced substantial water level variability in the past century, yet causes of recent changes in many lakes remain unexplored. Modelling hydrological processes for CA lakes poses challenges in separating climatic change impacts from human management impacts due to limited data and long-term variability in hydrological regimes. This study developed a spatially lumped empirical model to investigate the effects of climate change and human water abstraction, using Shortandy Lake in Burabay National Nature Park (BNNP) as a case study. Modelling results show a significant water volume decline from 231.7x106m3 in 1986 to 172.5x106m3 in 2016, primarily driven by anthropogenic water abstraction, accounting for 92% of the total volume deficit. The highest rates of water abstraction (greater than 25% of annual outflow) occurred from 1989 to 1993, coinciding with the driest period. Since 2013, the water volume has increased due to increased precipitation and, more importantly, reduced water abstraction. Despite limited observational data with which to calibrate the model, it performs well. Our analysis underscores the challenges in modelling lakes in data-sparse regions such as CA, and highlights the importance and benefits of developing lake water balance models for the region.

The mortality burden related to COVID-19 in 2020 and 2021 - years of life lost and excess mortality in 13 countries and sub-national regions in Southern and Eastern Europe, and Central Asia.

Introduction: Between 2021 and 2023, a project was funded in order to explore the mortality burden (YLL-Years of Life Lost, excess mortality) of COVID-19 in Southern and Eastern Europe, and Central Asia. Methods: For each national or sub-national region, data on COVID-19 deaths and population data were collected for the period March 2020 to December 2021. Unstandardized and age-standardised YLL rates were calculated according to standard burden of disease methodology. In addition, all-cause mortality data for the period 2015-2019 were collected and used as a baseline to estimate excess mortality in each national or sub-national region in the years 2020 and 2021. Results: On average, 15-30 years of life were lost per death in the various countries and regions. Generally, YLL rates per 100,000 were higher in countries and regions in Southern and Eastern Europe compared to Central Asia. However, there were differences in how countries and regions defined and counted COVID-19 deaths. In most countries and sub-national regions, YLL rates per 100,000 (both age-standardised and unstandardized) were higher in 2021 compared to 2020, and higher amongst men compared to women. Some countries showed high excess mortality rates, suggesting under-diagnosis or under-reporting of COVID-19 deaths, and/or relatively large numbers of deaths due to indirect effects of the pandemic. Conclusion: Our results suggest that the COVID-19 mortality burden was greater in many countries and regions in Southern and Eastern Europe compared to Central Asia. However, heterogeneity in the data (differences in the definitions and counting of COVID-19 deaths) may have influenced our results. Understanding possible reasons for the differences was difficult, as many factors are likely to play a role (e.g., differences in the extent of public health and social measures to control the spread of COVID-19, differences in testing strategies and/or vaccination rates). Future cross-country analyses should try to develop structured approaches in an attempt to understand the relative importance of such factors. Furthermore, in order to improve the robustness and comparability of burden of disease indicators, efforts should be made to harmonise case definitions and reporting for COVID-19 deaths across countries.

Changes in alcohol, tobacco, cannabis, and other substance use and its association with mental health during the COVID-19 pandemic among sexual minority men in Eastern European and Central Asian countries.

BACKGROUND: The COVID-19 pandemic had a particularly negative impact on mental wellbeing of vulnerable individuals, such as sexual minority men (SMM) living in Eastern Europe and Central Asia (EECA), where the social-political climate may be restrictive for SMM. Alcohol, tobacco, and other drugs (ATOD) use may be another factor contributing to exacerbated mental health among SMM in this region. METHODS: Secondary analyses were conducted using data collected as part of the COVID-19 disparities survey from active users of Hornet, a popular geo-social networking app for SMM in late 2020. Using a subset of SMM living in EECA (n = 3209) and pre-validated scales (AUDIT-C and PHQ-4), we used multivariable logistic regression models to examine the relationship between changes in participants' use of ATOD and their mental wellbeing. RESULTS: Based on AUDIT-C, 35.1 % SMM screened for alcohol use disorder (AUD), 18.6 % reported an increase in alcohol use since the pandemic began. Over 30 % screened for depressive symptoms and anxiety based on PHQ-4 (30.4 % and 30.7 %, respectively). In multivariable models, AUD was significantly associated with screening positive for depressive symptoms and anxiety. Other factors associated with mental distress included lower socioeconomic status, unemployment, ethnic minority identity, IPV victimization, and financial and economic vulnerability. LIMITATIONS: Cross-sectional data cannot be used to infer causality. CONCLUSIONS: Our results support the needs for integrated substance use reduction and mental health services tailored for SMM in EECA. Programs aimed at promoting mental wellbeing among SMM in EECA must consider both interpersonal and structural barriers.

Grassland productivity in arid Central Asia depends on the greening rate rather than the growing season length.

Climate change has induced substantial impact on the gross primary productivity (GPP) of terrestrial ecosystems by affecting vegetation phenology. Nevertheless, it remains unclear which among the mean rates of grass greening (RG), yellowing (RY), and the length of growing season (LOS) exhibit stronger explanatory power for GPP variations, and how RG and RY affect GPP variations under warming scenarios. Here, we explored the relationship between RG, RY, LOS, and GPP in arid Central Asia (ACA) from 1982 to 2019, elucidating the response mechanisms of RG, RY, and GPP to the mean temperature (TMP), vapor pressure deficit (VPD), precipitation (PRE), and soil moisture (SM). The results showed that the multi-year average length of greening (LG) in ACA was 22.7 days shorter than that of yellowing (LY) and the multi-year average GPP during LG (GPPlg) was 38.28 g C m-2 d -1 more than that of during LY (GPPly). RG and RY were positively correlated with GPPlg and GPPly, although the degree of correlation between RG and GPPlg was higher than that between RY and GPPly. Increases in RG and RY contributed to an increase in GPPlg (55.44 % of annual GPP) and GPPly (35.44 % of annual GPP). The correlation between RG and GPPlg was the strongest (0.49), followed by RY and GPPly (0.33), and LOS and GPP was the weakest (0.21). TMP, VPD, PRE, and SM primarily affected GPP by influencing RG and RY, rather than direct effects. The positive effects of TMP during LG (TMPlg), PRE during LG (PRElg), and SM during LG (SMlg) facilitated increases in RG and GPPlg, and higher VPD during LY (VPDly) and lower PRE during LY (PREly) accelerated increases in RY. Our study elucidated the impact of vegetation growth rate on GPP, thus providing an alternate method of quantifying the relationship between vegetation phenology and GPP.

Global Neurosurgical Challenges: A Focus on Central Asia.

OBJECTIVE: To evaluate the current state of neurosurgical care in Central Asia, identify the challenges and advancements, and propose recommendations to improve neurosurgical capabilities and access in Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. METHODS: A comprehensive review of the neurosurgical infrastructure, availability of neurosurgeons, technological advancements, and healthcare policies in the five Central Asian countries. Analysis included published literature, healthcare reports, and expert opinions to assess the state of neurosurgical care and identify areas for improvement. RESULTS: Significant variation in neurosurgical care was observed across the region. Kazakhstan showed notable advancements, including an increased number of neurosurgeons and progress in specialized fields such as vascular neurosurgery and brain tumor management. Other countries, like Uzbekistan, Tajikistan, and Kyrgyzstan, made strides in improving neurosurgical care but still faced substantial challenges. Common issues included a shortage of neurosurgeons, limited facilities, and inadequate access to modern technology. The lack of research data further highlighted the need for urgent intervention. CONCLUSIONS: To enhance neurosurgical care in Central Asia, a multipronged approach involving targeted investments, policy reforms, international collaborations, and knowledge sharing is recommended. This includes establishing specialized neurosurgical training programs and fellowships, investing in infrastructure and technology, fostering international collaborations for training and research, introducing early neurosurgery education in medical schools, improving access to online education resources, and promoting telemedicine for consultations and follow-up care. These measures are necessary to expand access to essential neurosurgical care and improve outcomes in the regions.

Assessing the impacts of crop production on climate change: An in-depth analysis of long-term determinants and policy implications.

This research investigates the long-term determinants of carbon emissions in three diverse regions-Europe and Central Asia (ECA), Sub-Saharan Africa (SSA), and the Middle East and North Africa (MENA)-spanning 1990 to 2020. Utilizing advanced econometric models and analyses, including the Regularized Common Correlated Effects Estimator (rCCE), Common Correlated Effects Estimator (CCE), and Mean-Group (MG) approach, the study explores the intricate relationships between carbon emissions, crop production, emissions per agricultural production, energy consumption, renewable energy consumption, per capita GDP, and population. Region-specific nuances are uncovered, highlighting the varying dynamics: ECA exhibits intricate and non-significant relationships, SSA showcases significant effects of population dynamics and green technology adoption, and the MENA region reveals a nuanced interplay between emissions per agricultural production.The findings underscore the universal efficacy of green technology adoption for mitigation. Strategies for mitigating carbon emissions in the agricultural sector require diversified energy transition approaches, emphasizing efficiency enhancements, green technology adoption, and tailored population management strategies based on regional intricacies. Counterfactual simulations indicate the potential efficacy of strategic measures targeting crop production to reduce carbon emissions, while acknowledging the nuanced relationship between economic growth and emissions. Policymakers are urged to recognize the persistence in emission patterns, emphasizing the importance of targeted interventions to transition towards more sustainable trajectories. Overall, the research provides essential insights for crafting effective policies at both regional and global scales to address the complexities of climate change mitigation in the agricultural sector.

Description of two new species of the genus Repetekiodes Amsel, 1961 (Lepidoptera: Pyralidae: Phycitinae) from Central Asia with faunal notes on the genus.

Two new species, Repetekiodes serratalis sp. nov. and Repetekiodes turanella sp. nov. are described from Central Asia. The described species are well distinguished from their congeners by the genitalia and forewing pattern. A brief overview of the genus Repetekiodes Amsel, 1961 is given and original data on the distribution of Repetekiodes species are provided. DNA barcode data are presented for several species of the genus.

Дорожная карта в поддержку здоровья и благополучия в Центральной Азии (2022–2025): достижения и возможности

В отчете оценивается прогресс, достигнутый с 2022 по середину 2024 г. в рамках реализации Дорожной карты в поддержку здоровья и благополучия в Центральной Азии (2022–2025 гг.) (далее по тексту – Дорожная карта) в пяти странах Центральной Азии (ЦА). Одобренная президентами Казахстана, Кыргызстана, Таджикистана, Узбекистана и поддержанная министрами здравоохранения всех стран ЦА, Дорожная карта охватывает 11 ключевых направлений деятельности и 32 инициативы по реформированию. В отчете представлены индивидуальные и совместные достижения стран ЦА в условиях поликризиса (изменение климата, пандемия COVID-19 и политическая нестабильность), а также подчеркивается необходимость партнерства и скоординированных действий для достижения политических, инвестиционных и технических целей, указанных в Дорожной карте. Европейское региональное бюро ВОЗ содействовало проведению дискуссий, обеспечивало политическое участие и предлагало техническую помощь, тем самым повышая роль здравоохранения как движущей силы социально-экономического прогресса в регионе. Конкретные достижения демонстрируют приверженность стран ЦА охране здоровья и благополучия людей, прокладывают путь к инклюзивному и стабильному будущему. Молодой возраст населения Центральной Азии позволяет ей стать лидером в области здравоохранения и экономического успеха в сотрудничестве с Европейским союзом и ВОЗ. Однако для реализации этих амбиций необходимы дальнейшие инвестиции в здравоохранение по всем 11 областям деятельности Дорожной карты. Расширение сотрудничества и финансирования необходимо для улучшения показателей здоровья и обеспечения экономического будущего региона.

Roadmap for health and well-being in Central Asia (2022–2025): progress and opportunities

The report evaluates the progress made from 2022 to mid-2024 under the Roadmap for health and well-being in Central Asia (2022–2025) (CARM) across five central Asian countries (CACs). Endorsed by the presidents of Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan and supported by the ministers of health of all CACs, the CARM addresses 11 key action areas and 32 reform initiatives. The report highlights individual and collaborative achievements for CACs amid a polycrisis (climate change, COVID-19 pandemic and political instability), emphasizing the need for partnerships and coordinated action to meet the CARM’s political, investment and technical objectives. The WHO Regional Office for Europe has facilitated discussions, provided political engagement and offered technical assistance, thereby elevating health as a driver of socioeconomic progress in the region. Specific accomplishments demonstrate CACs’ dedication to health and well-being, paving the way for an inclusive and sustainable future. The youthful population of Central Asia positions it to become a leader in health and economic success, in collaboration with the European Union and WHO. However, achieving these ambitions requires further investment in health, focusing on all 11 action areas of CARM. Increased collaboration and funding are essential to improve health outcomes and safeguard the region’s economic future.

Current Trends of HIV Infection in the Russian Federation.

Russia remains one of the areas most affected by HIV in Eastern Europe and Central Asia. The aim of this study was to analyze HIV infection indicators and study trends in Russia using data from the Federal Statistic Form No. 61 "Information about HIV infection". HIV incidence, prevalence, HIV testing and mortality rates (from 2011 to 2022), and treatment success rates (from 2016 to 2022) were analyzed. These indicators were compared across different federal districts (FDs) of Russia. The findings revealed a significant downward trend in HIV incidence, while a significant upward trend was observed for HIV prevalence. The mortality rate has stabilized since 2018. The coverage of HIV testing and antiretroviral therapy increased over time. The number of people living with HIV-1 (PLWH) with a suppressed viral load in Russia as a whole varied between 72% and 77% during the years under observation. The Siberian and Ural federal districts recorded the highest HIV incidence, while the North Caucasian FD reported the lowest. An increase in HIV testing coverage was observed across all FDs. This comprehensive evaluation of HIV infection indicators within the regional context contributes to the timely implementation of measures aimed at preventing the spread of HIV.

The Burden of Disease due to COVID-19 (BoCO-19): A study protocol for a secondary analysis of surveillance data in Southern and Eastern Europe, and Central Asia.

INTRODUCTION: The COVID-19 pandemic has had an extensive impact on public health worldwide. However, in many countries burden of disease indicators for COVID-19 have not yet been calculated or used for monitoring. The present study protocol describes an approach developed in the project "The Burden of Disease due to COVID-19. Towards a harmonization of population health metrics for the surveillance of dynamic outbreaks" (BoCO-19). The process of data collection and aggregation across 14 different countries and sub-national regions in Southern and Eastern Europe and Central Asia is described, as well as the methodological approaches used. MATERIALS AND METHODS: The study implemented in BoCO-19 is a secondary data analysis, using information from national surveillance systems as part of mandatory reporting on notifiable diseases. A customized data collection template is used to gather aggregated data on population size as well as COVID-19 cases and deaths. Years of life lost (YLL), as one component of the number of Disability Adjusted Life Years (DALY), are calculated as described in a recently proposed COVID-19 disease model (the 'Burden-EU' model) for the calculation of DALY. All-cause mortality data are collected for excess mortality sensitivity analyses. For the calculation of Years lived with disability (YLD), the Burden-EU model is adapted based on recent evidence. Because Covid-19 cases vary in terms of disease severity, the possibility and suitability of applying a uniform severity distribution of cases across all countries and sub-national regions will be explored. An approach recently developed for the Global Burden of Disease Study, that considers post-acute consequences of COVID-19, is likely to be adopted. Findings will be compared to explore the quality and usability of the existing data, to identify trends across age-groups and sexes and to formulate recommendations concerning potential improvements in data availability and quality. DISCUSSION: BoCO-19 serves as a collaborative platform in order to build international capacity for the calculation of burden of disease indicators, and to support national experts in the analysis and interpretation of country-specific data, including their strengths and weaknesses. Challenges include inherent differences in data collection and reporting systems between countries, as well as assumptions that have to be made during the calculation process.

Breast and cervical cancer screening practices in nine countries of Eastern Europe and Central Asia: A population-based survey.

BACKGROUND: Eastern Europe and Central Asia (EECA) countries have higher cervical and breast cancer mortality rates and later stage at diagnosis compared with the rest of WHO European Region. The aim was to explore current early detection practices including "dispensarization" for breast and cervix cancer in the region. METHODS: A questionnaire survey on early detection practices for breast and cervix cancer was sent to collaborators in 11 countries, differentiating services in the primary health setting, and population-based programs. Responses were received from Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, the Russian Federation (Arkhangelsk, Samara and Tomsk regions), Tajikistan, Ukraine, and Uzbekistan. RESULTS: All countries but Georgia, Kyrgyzstan, and the Russian Federation had opportunistic screening by clinical breast exam within "dispensarization" program. Mammography screening programs, commonly starting from age 40, were introduced or piloted in eight of nine countries, organized at national oncology or screening centres in Armenia, Belarus and Georgia, and within primary care in others. Six countries had "dispensarization" program for cervix cancer, mostly starting from the age 18, with smears stained either by Romanowsky-Giemsa alone (Belarus, Tajikistan and Ukraine), or alternating with Papanicolaou (Kazakhstan and the Russian Federation). In parallel, screening programs using Papanicolaou or HPV test were introduced in seven countries and organized within primary care. CONCLUSION: Our study documents that parallel screening systems for both breast and cervix cancers, as well as departures from evidence-based practices are widespread across the EECA. Within the framework of the WHO Initiatives, existing opportunistic screening should be replaced by population-based programs that include quality assurance and control.

Human migration in the eastern Tianshan Mountains between the 7th and 12th centuries.

OBJECTIVE: Mid- to late-Holocene large-scale population migration profoundly impacted the interaction of ethnic groups and cultures across Eurasia, notably in Central Asia. However, due to a lack of thorough historical documents, distinctive burial items, and human remains, the process of population migration during this historical era in the area is still unclear. Using an interdisciplinary approach at the Lafuqueke (LFQK) cemetery, this study investigates the spatiotemporal processes and explores the factors that influenced human migration in the eastern Tianshan Mountains between the 7th and 12th centuries. MATERIALS AND METHODS: In this study, tooth enamel from 56 human remains found in the LFQK cemetery in Hami Basin, eastern Tianshan Mountains, is examined for strontium and lead isotopes. RESULTS: The early, middle, and late phases of migration might potentially be represented by a three-phase migration model, according to the isotopic study. The highest proportion of the early phase (ca. 7th-mid 7th century) comprised non-locals (54.55%), although this percentage decreased in the middle phase (mid 7th-mid 8th centuries, 30.77%). After the 10th century, the proportion of non-locals again fell (16.13%). CONCLUSION: In this study, the interdisciplinary approach was employed to propose a new model for the diachronic changes that accompanied human migration and cultural interaction in the eastern Tianshan Mountains and identified geopolitics as a significant factor influencing the migratory behavior of LFQK population in this region between the 7th and 12th centuries.

WHO Regional Office for Europe Antimicrobial Medicines Consumption (AMC) Network: AMC data 2020–2021

This report presents analyses of data on antimicrobial medicines consumption collected from non-European Union countries in the WHO European Region – 13 countries provided 2020 data and 10 countries provided 2021 data. The analyses show the results for key metrics of antibiotic consumption including total use, relative use of agents according to the WHO Access, Watch and Reserve (AWaRe) classification, and concordance with WHO monitoring indicators for responsible use of antibiotics. Analyses explore the possible impact of the COVID-19 epidemic on volumes and patterns of consumption of antibiotics.

Policy dialogue to strengthen mental health in the Central Asian Republics: 25–26 April 2023 Tashkent, Uzbekistan: meeting report

The WHO Regional Office for Europe organized three subregional policy dialogues to provide a platform for representative of the Central Asian Republics to discuss ways to strengthen policy and practice in service of the WHO/Europe Roadmap for Health and Well-being in the Central Asian Countries. The second of these policy dialogues, held in Tashkent, Uzbekistan on 25–26 April 2023, focused on strengthening mental health systems in the subregion and was held within the frame of the pan-European Mental Health Coalition. Across the two days, countries identified main priorities for addressing mental health going forward.